急性脑梗死患者血胆红素、高敏C反应蛋白和同型半胱氨酸的表达及其临床意义

目的观察血胆红素、高敏C反应蛋白（hs—CRP）和同型半胱氨酸（Hcy）在急性脑梗死患者中的表达,并分析其临床意义。方法选择2011年1月～2012年12月上海市第一人民医院宝山分院收治的急性脑梗死患者198例,按照神经功能缺损评分标准分为轻型（0～15分）82例,中型（16～30分）61例,重型（31～45分）55例,选取同期颈动脉粥样硬化（AS）的体检者30例为对照组。分析两组胆红素、hs—CRP和Hey水平变化．观察胆红素、hs—CRP和Hcy水平与急性脑梗死严重程度的关系。结果急性脑梗死组hs—CRP[（14．82±1．93）mg／L1和Hey[（23．76±8．59）μmol／L]水平较对照组[（1．24±0．47）mg／L、（7．23±3．82）μmol／L]明显升高,差异有高度统计学意义（P〈0．01）;急性脑梗死组TBIL[（11．91±3．82）μmol／L]和IBIL[（6．54±1．26）μmol／L]水平较对照组[（15．53±2．18）、（9．95±2．98）μmol／L]明显降低,差异有高度统计学意义（P〈0．01）;两组的DBIL水平差异无统计学意义（P〉0．05）。重型组患者hs—CRP和Hcy水平[（18．04±2．27）mg／L、（27．73±8．03）mg／L1高于中型组[（14．93±2．02）mg／L、（24．06±8．63）μmol／L]和轻型组[（12．58±1．18）mg／L、（20．87±7．52）μmol／L]患者,中型组hs—CRP和Hcy水平高于轻型组患者,差异有统计学意义（P〈0．05或P〈0．01）;重型组患者TBIL和IBIL水平f（8．97±2．08）、（3．64±3．29）Wmol／L]低于中型组[（10．87±2．37）mg／L、（5．51±2．87）μmol／L]和轻型组[（14．65±3．98）mg／L、（9．25±2．25）μmol／L]患者,中型组TBIL和IBIL水平低于轻型组患者,差异均有统计学意义（P〈0．05或P〈0．01）;各组DBIL水平差异无统计学意义（P〉0．05）。结论胆红素、hs—CRP和Hcy水平参与了急性脑梗死疾病发生发展,急性脑梗死的严重程度与血胆红素、hs—CRP和Hey水平有关。     

低氧诱导因子-1α在溃疡性结肠炎中的表达

目的 探讨低氧诱导因子-1α(HIF-1α)在溃疡性结肠炎(UC)组织中的表达及与疾病活动性的关系.方法 采用免疫组织化学方法检测47例UC患者(活动期35例、缓解期12例)和20例正常对照组中HIF-1α的表达.结果 溃疡性结肠炎患者活动期HIF-1α表达显著高于正常人,差异有显著性(152.27±16.26)vs(193.28±16.65)(P＜0.01),缓解期HIF-1α表达与正常人差异无显著性(185.93±11.80)vs(193.28±16.65)(P＞0.05),溃疡性结肠炎中HIF-1α的表达与Walmsley评分标准有相关性,且呈正相关.结论 HIF-1α作为一种转录因子可能参与了UC的发病过程并与疾病的活动性有关.     

肺移植术后原发性移植物功能丧失的预防和治疗

目的 探讨肺移植术后原发性移植物功能丧失(PGD)的预防和治疗.方法 回顾性分析2002年9月至2011年6月间108例肺移植的临床资料.术后监测所有受者的血液气体分析及胸部X线表现,连续监测有创动脉压、肺动脉压和(或)中心静脉压.术后3d保持受者液体负平衡,根据动脉血氧分压(PaO2)和(或)血氧饱和度控制吸入氧浓度(FiO2),根据血液气体分析结果及生命体征调节呼吸机通气参数,以预防PGD的发生.术后早期一旦出现PaO2、FiO2急剧下降(低于200),且胸部X线片显示移植肺中下肺野密度增高,在排除超急性排斥反应、静脉吻合口梗阻、心源性肺水肿及肺部感染后,根据国际心肺移植协会制定的标准将PGD分级为3级的患者明确诊断为PGD.对于PGD级别的不同,分别给予受者加强通气支持、液体负平衡、延长呼吸机治疗时间、使用肺血管扩张药如前列地尔及使用ECMO等治疗措施.结果 术后共有10例受者发生PGD,发生率为9.3％(10/108).10例患者中,6例常规使用呼吸机支持治疗,持续时间为(285.8±238.6)h,其中2例逆转,4例死于PGD后呼吸衰竭;4例使用了体外膜肺氧合(ECMO)辅助治疗,其中2例在发生PGD后24 h内应用了ECMO,成功逆转后长期存活,另2例由于应用时间较晚(24 h后),病情恶化,分别在应用ECMO后第8和第11天死于PGD导致的急性肾功能衰竭和多器官功能衰竭.结论 肺移植后PGD的发生率高,应在围手术期加强管理,进行积极预防;一旦受者发生PGD,应尽快给予相应治疗,如达到使用EC MO的指征,应尽早使用.     

膀胱炎性肌纤维母细胞瘤2例报告并文献复习

目的：探讨膀胱炎性肌纤维母细胞瘤的临床、病理、组织生化特性和诊治方法及预后。方法：报告2例肉眼血尿伴重度贫血的膀胱炎性肌纤维母细胞瘤患者的诊治资料,并结合文献进行探讨。结果：膀胱炎性肌纤维母细胞瘤以肉眼血尿和尿痛为最常见症状,肿瘤好发于膀胱底部、顶壁、侧壁;组织学由具有平滑肌细胞和纤维母细胞特征的梭形细胞、大量慢性炎性细胞及血管样黏液构成。1例随访3年,1例随访6个月,均无瘤存活。结论：膀胱炎性肌纤维母细胞瘤为低度恶性肿瘤,罕见。确诊依据病理学检查,应与平滑肌肉瘤、横纹肌肉瘤、梭形细胞癌等鉴别;治疗原则以切除肿瘤、保留膀胱功能为主,TUPKBT、TURBT或膀胱部分切除术,术后辅以化疗药物膀胱灌注,效果佳。     

胰腺浆液性微囊性腺瘤临床病理分析

目的 探讨胰腺浆液性微囊性腺瘤的临床病理特征及其诊断与鉴别诊断.方法 对7例胰腺浆液性微囊性腺瘤病例的临床资料、病理形态、免疫组化进行分析.结果 7例患者均为女性,平均年龄51岁,有临床症状者2例(28.6％).镜下肿瘤主要由大小不等的囊腔组成,囊壁衬覆单层立方上皮,细胞胞质透明并富含糖原.上皮细胞核小而圆,居中,无核仁,无核分裂象.部分囊腔之间可见粗大的纤维组织分隔.免疫组化上皮细胞AE1/AE3、CK7、CK8、CK19、CK/LMW、EMA(+);CEA、CD31、CD34、D2-40、Syn、CgA、Calretinin、Vim(一).结论 胰腺浆液性微囊性腺瘤是一种较为少见的良性肿瘤,老年女性好发,预后好,确诊主要靠术后病理组织学和免疫组化.     

Laparoscopic Mesh Versus Open Preperitoneal Mesh Versus Conventional Technique for Inguinal Hernia Repair: A Randomized Multicenter Trial (SCUR Hernia Repair Study)

OBJECTIVE: To evaluate the influence of the laparoscopic technique in hernia repair regarding time to full recovery and return to work, complications, recurrence rate, and economic aspects. SUMMARY BACKGROUND DATA: Several studies have shown advantages in terms of less pain and faster recovery after laparoscopic hernia repair, whereas others have not, and the cost-effectiveness has been questioned. The laparoscopic technique must be thoroughly compared with the open procedures before its true place in hernia surgery can be defined. METHODS: Six hundred thirteen male patients aged 40 to 75 years were randomized to the conventional procedure, preperitoneal mesh placed by the open technique, or laparoscopic preperitoneal mesh (TAPP). Follow-up was after 7 days, 8 weeks, and 1 year. RESULTS: Of 613 patients undergoing surgery, 604 (98.5%) were followed for 1 year. Patients who underwent TAPP gained full recovery after 18.4 days, compared with 24.2 days for open mesh (p < 0.001) and 26.4 days for the conventional procedure (p < 0.001). Patients who underwent TAPP returned to work after 14.7 days, compared with 17.7 days for open mesh (p = 0.05) and 17.9 days for the conventional procedure (p = 0.04). They also had significantly less restriction in physical activities after 7 days. The TAPP procedure was more expensive, mainly as a result of longer surgical time and equipment costs, even after compensation for earlier return to work. Complications were more common in the TAPP group, with a varying pattern between the groups. Four recurrences in the conventional, 11 in the open mesh, and 4 in the TAPP group were recorded after 1 year (p = n.s.). CONCLUSION: The laparoscopic technique results in both shorter time to full recovery and shorter time to return to work, at the price of substantially increased costs.     

植入用缓释氟尿嘧啶治疗结直肠癌的实验研究

目的 研究氟尿嘧啶（5-Fu）缓释植入剂对结直肠癌移植瘤的治疗效果.方法 将50只直肠癌荷瘤鼠随机分为5组,每组10只.A、B组于瘤周植入5-FU缓释剂,剂量分别为200mg/kg和100 mg/kg;C、D组于瘤周注射5-FU注射液,剂量分别为200 mg/kg和100 mg/kg;E组不予任何治疗.分别于给药后0、3、6、9和12 d,观察裸鼠生存情况、体质量变化及肿瘤体积,12 d后处死小鼠.结果 A、B组肿瘤生长曲线平缓,12 d后A、B、C及D组抑瘤率分别为72%、51%、8%及5%,A、B组肿瘤体积与C、D组比较,差异有统计学意义（P＜0.05）.A、B、C和D组在给药3 d后体质量下降,其中以C组最为明显;以后各组体质量增加,12 d后,各组小鼠体质量间差异无统计学意义（P＞0.05）.在实验过程中,A、B、C和D组小鼠分别死亡1、0、4和1只.结论 5-FU缓释植入剂于瘤周植入能安全有效地抑制结直肠癌移植瘤的生长.     

正颌联合术后正畸矫治唇腭裂术后的牙颌面畸形

目的探讨应用正颌手术联合术后正畸矫治唇腭裂术后牙颌面畸形的方法。方法2002年1月至2010年8月,共收治25例唇腭裂术后颌骨畸形患者。男11例,女14例;年龄16～33岁;单侧唇腭裂19例,双侧6例。所有患者术前均未接受过正畸治疗。本组患者均联合应用正颌手术和术后正畸建牙合矫治唇腭裂术后颌骨畸形。结果25例患者经过3~12个月的术后正畸治疗,均建立了良好的咬牙合关系,恢复正常咬合功能。随访6个月至3年,术后疗效稳定。结论唇腭裂术后颌骨畸形采用正颌手术联合术后正畸能够有效矫治牙颌面畸形。     

Tissue factor produced by the endocrine cells of the islets of Langerhans is associated with a negative outcome of clinical islet transplantation

There are strong indications that only a small fraction of grafts successfully engraft in clinical islet transplantation. One explanation may be the instant blood-mediated inflammatory reaction (IBMIR) elicited by tissue factor, which is produced by the endocrine cells. In the present study, we show that islets intended for islet transplantation produce tissue factor in both the transmembrane and the alternatively spliced form and that the membrane-bound form is released as microparticles often associated with both insulin and glucagon granules. A low-molecular mass factor VIIa (FVIIa) inhibitor that indirectly blocks both forms of tissue factor was shown in vitro to be a promising drug to eliminate the IBMIR. Thrombin-antithrombin complex (TAT) and FVIIa-antithrombin complex (FVIIa-AT) were measured in nine patients who together received 20 infusions of isolated human islets. Both the TAT and FVIIa-AT complexes increased rapidly within 15-60 min after infusion. When the initial TAT and FVIIa-AT levels were plotted against the increase in C-peptide concentration after 7 days, patients with an initially strong IBMIR showed no significant increase in insulin synthesis after 7 days. In conclusion, tissue factor present in both the islets and the culture medium and elicits IBMIR, which affects the function of the transplanted islets.